乌克兰的军事医学是一个关键的优势

![](/media/202412//1733471357.7145004.png)

乌克兰的军事医学是一个关键的优势

![](/media/202412//1733471357.7231464.png)

**俄罗斯过时的训练和装备正在使士兵们牺牲其生命。**

凭借[**塔尼沙M.法扎尔**](https://foreignpolicy.com/author/tanisha-m-fazal/)他是明尼苏达大学的政治学教授。

![](/media/202412//1733471357.7318497.jpeg)

10月9日，一名麻醉师准备在乌克兰顿涅茨克区的一家医院接受军事病人的治疗。

10月9日，一名麻醉师准备在乌克兰顿涅茨克区的一家医院接受军事病人的治疗。宝拉布朗斯坦/盖蒂的图片

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2022年10月31日，下午1：10

![](/media/202412//1733471357.7486708.png)[俄罗斯对乌克兰的持续入侵已经花费了100多美元](https://www.devex.com/news/funding-tracker-who-s-sending-aid-to-ukraine-102887)

[自2月份以来提供了数十亿美元的援助，联合国的几次投票](https://www.devex.com/news/funding-tracker-who-s-sending-aid-to-ukraine-102887)

被转让或出售的[高科技武器系统](https://apnews.com/article/russia-ukraine-zelenskyy-nato-sergey-lavrov-dd7bc9324e465a15209940c146a859b3)来自美国

包括HIMARS火箭发射系统，

开关刀600无人机和手垫防空系统但是.

西方对乌克兰的援助的另一个更平淡的部分是

对冲突的显著影响：[医药用品](https://www.federalregister.gov/documents/2022/05/31/2022-11612/update-to-the-list-of-medical-supplies-for-ukraine-russia-related-sanctions).军事医学在很大程度上是一个很大程度上被忽视的贡献者，但它的影响在战场上实时发挥作用。

从更好的现场卫生到机械化和空中疏散，以及现代的防弹衣，今天的军队利用这些

改变不仅可以拯救生命，而且还可以保持他们的力量的力量。例如，在第一次世界大战中，受伤的美国士兵可以等待

他们将被疏散到几英里外的一家野战医院；相比之下，在阿富汗战争期间，美国人受伤了。军人

将被疏散到美国。德国兰德斯图尔的军事医院，甚至在一两天内返回美国。

![](/media/202412//1733471357.7731154.png)

本文发表在《外交政策》杂志2023年冬季刊上。[**探索这个问题。**](https://foreignpolicy.com/the-magazine/?=winter23print_tp)

![](/media/202412//1733471357.7964232.png)大家都说，乌克兰的军事药物比俄罗斯好得多。[例如，乌克兰军队在战术战斗方面受过良好的训练](https://jts.health.mil/index.cfm/committees/cotccc)

[伤亡护理（TCCC），一套院前指南，由](https://jts.health.mil/index.cfm/committees/cotccc)U.S.20世纪90年代，早期修订和广泛采用

多年的阿富汗战争和伊拉克战争。美国军事医疗

习艺者[建立](https://www.east.org/content/documents/MilitaryResources/b/TCCC%20Eastridge%20Death%20on%20the%20Battlefield%20J%20Trauma%202012.pdf)那87%的可预防的战斗死亡人数

发生在院前环境中；其中，大多数人死于出血。因此，TCCC指南严重关注出血，并建议何时使用止血带，止血剂

用敷料和夹子来防止失血。来自西方的援助已经到位

![](/media/202412//1733471357.807312.png)完全包括这些物资，以及相关的装备，如防弹衣。西方顾问也一直在推动在遥远的环境中使用全血。乌克兰的一个原因

医疗上的优势是，它不仅从今年2月以来，而且在过去8年里都欢迎这种援助。自2014年入侵克里米亚以来，乌克兰一直在为与俄罗斯的全面战争做准备，包括在医疗方面。

另一方面，俄罗斯军队缺乏医疗训练和物资。A[最近的视频](https://twitter.com/Reevellp/status/1574726637412753408)据报道，它在社交媒体上被广泛分享

![](/media/202412//1733471357.827669.png)显示俄罗斯军官要求新应征士兵购买卫生棉条[塞子弹的伤口。俄罗斯一直面临军事短缺](https://vpk-news.ru/articles/40126)

![](/media/202412//1733471357.8363652.png)[多年的医疗人员配备。俄罗斯的士气也是如此](https://vpk-news.ru/articles/40126)[据报道很低](https://www.nytimes.com/2022/10/10/world/europe/ukraine-war-south.html)[,](https://vpk-news.ru/articles/40126)[从现场报告和俄罗斯人的流动中都可以看出这是一个国家，以便不应征入伍。士气低落的原因之一](https://www.pbs.org/newshour/world/russian-men-leave-country-fearing-call-to-fight-in-ukraine)是否可能有关于医疗保健和供应不足的报告，包括使用这些药物的情况

![](/media/202412//1733471357.8450973.png)[苏联时代的急救儿童和有限的药品](https://pulitzercenter.org/stories/how-moms-not-ministry-defense-provide-russian-army).而俄罗斯[人员已经](https://topwar.ru/203503-tehnika-nalozhenija-zhguta-pri-ranenii-v-nogu.html)[TCCC方面的一些培训](https://www.nato.int/nrc-website/en/articles/20130307-nrc-military-medicine/index.html)[，他们似乎缺乏关键因素现代装备，如战斗应用止血带](https://topwar.ru/203503-tehnika-nalozhenija-zhguta-pri-ranenii-v-nogu.html)

实施这些指导方针。

更好的军事医学在战场上至少有三个问题

理由首先，拥有更好的药物意味着拯救更多的生命；换句话说，拥有更好药物的军队可以带来更多的人

与…作斗争他们在战争开始时可能会更健康，而且在其他同等条件下，他们将更有可能接受治疗，使他们能够尽早返回工作岗位。

第二，有更好的药物治疗意味着更高的可能性

保持单位的凝聚力；而不是被送回家(或者更糟的是，

受伤的士兵可以接受治疗并被送回他们的部队。社会纽带是可以维持的。新部队不必集结

训练第三，更好的药物治疗意味着提高军队的士气。

知道你和你的战友们会得到良好的治疗

在生病或受伤的时候，小心点会使你更愿意战斗和冒险。这意味着一个国家不愿浪费其士兵的生命

——这与俄罗斯大规模动员经常未经训练的士兵时所表现出的态度形成了鲜明对比。

这些因素在美国最近的研究中都很明显

在阿富汗和伊拉克的战争。创建一个[创伤登记处](https://jts.health.mil/index.cfm/about/origins#:~:text=Origins,Registry%2C%20Dec%2022%2C%202004.)2004年促进了军事医疗数据收集方面的一场革命

转向，允许研究的基础指南，如TCCC。这个

对阻止失血量的强烈关注导致了该发明和使用

![](/media/202412//1733471357.8548574.png)[新型止血带、止血敷料和导管](https://pubmed.ncbi.nlm.nih.gov/22182896/)

[维持血液流动。并理解它的关键重要性](https://pubmed.ncbi.nlm.nih.gov/22182896/)

尽快提供护理[为提示台词](https://www.nytimes.com/2009/01/28/washington/28military.html)美国国防部长

罗伯特·盖茨在2009年实施了“黄金时间”规则

![](/media/202412//1733471357.8645802.png)任何受伤的U.S.military人员将在受伤的第一个、最关键的小时内被疏散到更高层次的医疗设施。这些变化加起来，使美国的伤死比增加了两倍，从伊拉克行动中传统的3：1增加到10：1

自由和持久的自由。

当然，这些战争在很多方面都是不可比拟的。一个关键的区别是，美国打击了反叛叛乱

在阿富汗和伊拉克。至少到目前为止，俄罗斯之间的冲突

乌克兰是一场传统的战争，更让人想起过去欧洲的陆地战争，而且伤亡人数也很一致。火炮而不是路边炸弹一直是造成伤害的主要机制。另一个重要的对比与空中疏散有关，这是节约的关键部分

伤员的生命。在这场战争中，乌克兰和俄罗斯都没有空中优势。因此，医疗后送受到了损害，尽管乌克兰的战斗更靠近本国领土，而且总体上更优越

后勤考虑到即时护理对生存几率的重要性，有限的医疗治疗有助于理解俄罗斯3：1的低估计。

同时，也有重要的相似之处，包括在周围[报告伤亡人数的政治观点](https://www.grid.news/story/global/2022/08/16/how-many-russian-soldiers-have-been-killed-in-ukraine-what-we-know-how-we-know-it-and-what-it-really-means/).例如，对俄罗斯伤亡人数的最佳估计并不是来自俄罗斯。相反

![](/media/202412//1733471357.8743484.png)[—只说不做](https://www.wsj.com/livecoverage/russia-ukraine-latest-news-2022-03-23/card/russia-lost-up-to-40-000-troops-in-ukraine-nato-estimates-xyZjWxinMDHzdeRZvAeD)和各种[西方情报机构](https://www.washingtonexaminer.com/policy/defense-national-security/russia-casualties-cia-chief)一直在报告[这些数字。乌克兰自己的伤亡报告一直很少最好的两国不愿报告的部分原因](https://www.grid.news/story/global/2022/04/01/a-gruesome-way-of-accounting-the-politics-of-body-counts-in-ukraine/)

伤亡是因为这样的报告会降低士气，包括

在军队中，但也在国内。这种做法说明了著名的“多佛效应”——指的是在多佛空军基地被卸载的覆盖着美国国旗的军用棺材的图像

美国但伤亡报告也已经成为信息战运动的一部分。乌克兰

示例，报告[1000俄罗斯人死亡](https://www.reuters.com/world/europe/ukraine-says-more-than-1000-russian-soldiers-killed-so-far-2022-02-25/)战争的第一天，而俄罗斯媒体声称乌克兰遭受了损失[4000损失](https://www.aljazeera.com/news/2022/9/13/how-are-pro-kremlin-russian-media-portraying-ukraines-victories)在九月的一周内。

实际的伤亡人数，尤其是在乌克兰方面

增加是由于[俄罗斯瞄准了乌克兰的医院](https://www.reuters.com/world/europe/who-raises-alarm-about-healthcare-knife-edge-ukraine-2022-05-17/)在

违反国际法除了对民用医疗基础设施的打击，比如对a[妇产科医院](https://www.bbc.com/news/world-europe-60675599)今年3月，俄罗斯军队也瞄准了这个目标[乌克兰医疗后送铁路线](https://www.voanews.com/a/speeding-west-ukraine-hospital-train-ferries-patients-to-safety/6523658.html).

然而，所有迹象都表明，乌克兰在这场战争中占据着医疗优势。药物当然还不够。在1939年的冬季战争中，芬兰人同样比苏联拥有医疗优势。芬兰使用了绝缘的医疗援助站，疏散了伤亡人员

雪橇，而且通常有更好的医疗人员和设施。尽管战争最终以苏联的胜利而结束，但医学却是

尽管如此，芬兰人仍然是一个倍增的力量，他们的人口要少得多，能够妥协苏联的胜利，而不是被击溃。在一场数字很重要的战争中，拥有更好药物的一方拥有明显的优势。

一张数字合成图像显示，在第一次世界大战的加里波利战役期间，军队在土耳其的澳扎克湾登陆。

![](/media/202412//1733471357.8851604.png)乌克兰的战争就像第一次世界大战，而不是第二次世界大战

西方对俄罗斯的入侵使用了错误的类比，并恶化了结果。

7月11日，一名游客在老挝万象的正假肢企业参观中心参观集束炸弹残骸展览。

乌克兰可以向东南亚学习

柬埔寨和老挝对美国战争的后果有直接的经验。集束炸弹，现在被部署在乌克兰的战场上。

3月22日，在班吉举行支持俄罗斯和中国进驻中非共和国的游行中，一名示威者举着一面俄罗斯国旗。

为什么瓦格纳集团不离开非洲

这个雇佣兵组织是普京建立的体系的产物，他无法在不破坏莫斯科的全球影响力的情况下废除它。

*本文发表在2023年冬季出版的《外交政策》杂志上*

*杂志*[***立即订阅***](https://foreignpolicy.com/subscribe/?tpcc=winter23print_bp)*支持我们的新闻报道。*

![](/media/202412//1733471370.2924793.png)

Ukraine’s Military Medicine Is a Critical Advantage

![](/media/202412//1733471370.3011827.png)

**Russia’s outdated training and equipment are costing soldiers their lives.**

By [**Tanisha M. Fazal**](https://foreignpolicy.com/author/tanisha-m-fazal/), a professor of political science at the University of Minnesota.

![](/media/202412//1733471370.310951.jpeg)

An anesthesiologist prepares to receive military patients at a hospital in Donetsk district, Ukraine, on Oct. 9.

An anesthesiologist prepares to receive military patients at a hospital in Donetsk district, Ukraine, on Oct. 9.Paula Bronstein/Getty Images

[My FP:](https://foreignpolicy.com/myfp) Follow topics and authors to get straight to what you like. Exclusively for FP subscribers. [Subscribe Now](https://foreignpolicy.com/2022/10/31/ukraine-military-medicine-russia-war/#) | [Log In](https://foreignpolicy.com/2022/10/31/ukraine-military-medicine-russia-war/#)

October 31, 2022, 1:10 PM

![](/media/202412//1733471370.31974.png)[Russia’s ongoing invasion of Ukraine has prompted more than $100](https://www.devex.com/news/funding-tracker-who-s-sending-aid-to-ukraine-102887)

[billion in aid since February, several votes at the United Nations, and](https://www.devex.com/news/funding-tracker-who-s-sending-aid-to-ukraine-102887)

the transfer or sale of [high-tech weapons systems](https://apnews.com/article/russia-ukraine-zelenskyy-nato-sergey-lavrov-dd7bc9324e465a15209940c146a859b3) from the United

States to Ukraine, including the HIMARS rocket launch system,

Switchblade 600 drones, and MANPADS air defense systems. But

another, more prosaic part of the West’s aid to Ukraine is having a

significant effect on the conflict: [medical supplies](https://www.federalregister.gov/documents/2022/05/31/2022-11612/update-to-the-list-of-medical-supplies-for-ukraine-russia-related-sanctions). Military medicine is a largely overlooked contributor to military effectiveness, but its effects are playing out in realtime on the battlefield.

From better field sanitation to mechanized and air evacuation, as well as modern body armor, armies today that take advantage of these

changes can not only save lives but also preserve the strength of their forces. In WorldWar I, for example, injured U.S. soldiers could wait

hours to be evacuated to a field hospital just a few miles away; during the war in Afghanistan, by contrast, injured U.S. military personnel

would be evacuated to the U.S. military hospital inLandstuhl, Germany, or even back to the United States within a day or two.

![](/media/202412//1733471370.3337035.png)

This article appears in the Winter 2023 print issue of *Foreign Policy* magazine. [**Explore the issue.**](https://foreignpolicy.com/the-magazine/?=winter23print_tp)

![](/media/202412//1733471370.3493998.png)By all accounts, Ukraine has much better military medicine than Russia. [Ukrainian forces, for example, are well trained in Tactical Combat](https://jts.health.mil/index.cfm/committees/cotccc)

[Casualty Care (TCCC), a set of prehospital guidelines developed by the](https://jts.health.mil/index.cfm/committees/cotccc) U.S. military in the 1990s and revised and widely adopted in the early

years of the Afghanistan and Iraq wars. U.S. military medical

practitioners [found](https://www.east.org/content/documents/MilitaryResources/b/TCCC%20Eastridge%20Death%20on%20the%20Battlefield%20J%20Trauma%202012.pdf) that 87 percent of preventable battle deaths

occurred in the prehospital setting; among these, the most by far were dying from hemorrhage. Thus, the TCCC guidelines focus heavily on hemorrhage,with advice on when to apply tourniquets, hemostatic

dressings, and clamps to stem blood loss. Aid from the West has

![](/media/202412//1733471370.3601997.png)included exactly these kinds of supplies, as well as related equipment such as body armor. Western advisors have also been pushing for the use of whole blood in far forward settings. One reason for Ukraine’s

medical advantage is that it has welcomed such aid not just since this February but over the past eight years. Since the invasion of Crimea in 2014, Ukraine has been prepping for all-out war with Russia, including on the medical front.

Russian forces, on the other hand, lack medical training as well as supplies. A [recent video](https://twitter.com/Reevellp/status/1574726637412753408) shared widely on social media reportedly

![](/media/202412//1733471370.3689525.png)showed Russian officers telling new conscripts to purchase tampons to [plug bullet wounds. Russia has suffered from shortages in military](https://vpk-news.ru/articles/40126)

![](/media/202412//1733471370.3767352.png)[medical staffing for years. Russian morale is also](https://vpk-news.ru/articles/40126) [reportedly quite low](https://www.nytimes.com/2022/10/10/world/europe/ukraine-war-south.html)[,](https://vpk-news.ru/articles/40126) [as seen from both field reports and the flow of Russian men leaving the country so as not to be drafted into the army. One reason for low morale](https://www.pbs.org/newshour/world/russian-men-leave-country-fearing-call-to-fight-in-ukraine) is likely reports of poor medical care and supply, including the use of

![](/media/202412//1733471370.386521.png)[Soviet-era first-aid kids and limited pharmaceuticals](https://pulitzercenter.org/stories/how-moms-not-ministry-defense-provide-russian-army). While Russian [personnel have had](https://topwar.ru/203503-tehnika-nalozhenija-zhguta-pri-ranenii-v-nogu.html) [some training in TCCC](https://www.nato.int/nrc-website/en/articles/20130307-nrc-military-medicine/index.html)[, they appear to lack crucial modern equipment—such as the combat application tourniquet—to](https://topwar.ru/203503-tehnika-nalozhenija-zhguta-pri-ranenii-v-nogu.html)

implement these guidelines.

Better military medicine matters on the battlefield for at least three

reasons. First, having better medicine means saving more lives; in other words, militaries with better medicine can bring more people to the

fight. They will likely be healthier at the start of the war and, all else equal, will be more likely to receive treatment that allows them to return to duty sooner rather than later.

Second, having better medicine means a higher likelihood of

maintaining unit cohesion; rather than being sent home (or worse,

dying), injured soldiers can be treated and returned to their unit. Social bonds can be maintained. New troops do not have to spin up on

training. And third, better medicine translates into higher troop morale.

Knowing that you and your fellow soldiers will receive good medical

care in the event of illness or injury will make you more willing to fight and take risks. It signifies a country unwilling to waste its soldiers’ lives

—in stark contrast to the attitude on display in Russia’s mass mobilization of often untrained soldiers.

Many of these factors were evident in the United States’ most recent

wars in Afghanistan and Iraq. The creation of a [trauma registry](https://jts.health.mil/index.cfm/about/origins#:~:text=Origins,Registry%2C%20Dec%2022%2C%202004.) in 2004 facilitated a revolution in military medical data collection, which, in

turn, allowed for the research underlying guidelines like TCCC. The

intense focus on stemming blood loss led to the invention and use of

![](/media/202412//1733471370.3963292.png)[new kinds of tourniquets, hemostatic dressings, and catheters to](https://pubmed.ncbi.nlm.nih.gov/22182896/)

[maintain blood flow. And understanding the critical importance of](https://pubmed.ncbi.nlm.nih.gov/22182896/)

delivering care as soon as possible [prompted](https://www.nytimes.com/2009/01/28/washington/28military.html) U.S. Defense Secretary

Robert Gates to implement the “golden hour” rule in 2009,such that

![](/media/202412//1733471370.40703.png)any injured U.S.military personnel would be evacuated to a higher-level medical facility within the first, most crucial hour of injury. Combined, these changes contributed to a tripling of the United States’ wounded- to-killed ratio, from the traditional 3:1 to 10:1 in Operations Iraqi

Freedom and Enduring Freedom.

Of course, there are many ways in which these wars are not comparable. One key difference is that the United States fought counterinsurgencies

in Afghanistan and Iraq. At least to date, the conflict between Russia

and Ukraine has been a conventional war more reminiscent of past land wars in Europe—and with accordant levels of casualties. Artillery rather than roadside bombs have been the main mechanism of injury. Another important contrast has to do with air evacuation, a key part of saving

the lives of the wounded. Neither Ukraine nor Russia has air superiority in this war. Thus, medical evacuation is compromised, although Ukraine is fighting closer to its own territory and with generally superior

logistics. Given the importance of immediate care to the odds of survival, limited medevac helps make sense of the surprisingly low estimates of the Russian wounded-to-killed ratio at 3:1.

At the same time, there are important similarities, including around the [politics of reporting casualty numbers](https://www.grid.news/story/global/2022/08/16/how-many-russian-soldiers-have-been-killed-in-ukraine-what-we-know-how-we-know-it-and-what-it-really-means/). The best available estimates of Russian casualties, for example, are not coming from Russia. Instead,

![](/media/202412//1733471370.4177935.png)[NATO](https://www.wsj.com/livecoverage/russia-ukraine-latest-news-2022-03-23/card/russia-lost-up-to-40-000-troops-in-ukraine-nato-estimates-xyZjWxinMDHzdeRZvAeD) and various [Western intelligence agencies](https://www.washingtonexaminer.com/policy/defense-national-security/russia-casualties-cia-chief) have been reporting [these numbers. Ukraine’s own casualty reporting has been scanty at best. Part of the reason for both countries’ reluctance to report](https://www.grid.news/story/global/2022/04/01/a-gruesome-way-of-accounting-the-politics-of-body-counts-in-ukraine/)

casualties is because such reporting can diminish morale—including

among military forces, but also domestically. This practice speaks to the well-known “Dover effect”—referring to the images of military coffins draped with American flags being unloaded at Dover Air Force Base—in

the United States. But it is also the case that casualty reporting has become part of the information warfare campaign. Ukraine, for

example, reported [1,000 Russian fatalities](https://www.reuters.com/world/europe/ukraine-says-more-than-1000-russian-soldiers-killed-so-far-2022-02-25/) after the first day of the war, while Russian media claimed that Ukraine had suffered [4,000 losses](https://www.aljazeera.com/news/2022/9/13/how-are-pro-kremlin-russian-media-portraying-ukraines-victories) in a single week in September.

Actual casualty numbers—especially on the Ukrainian side—have

increased as a result of [Russian targeting of Ukrainian hospitals](https://www.reuters.com/world/europe/who-raises-alarm-about-healthcare-knife-edge-ukraine-2022-05-17/), in

violation of international law. In addition to strikes on civilian medical infrastructure, such as that on a [maternity hospital](https://www.bbc.com/news/world-europe-60675599) in March, Russian forces have also targeted [Ukrainian medical evacuation rail lines](https://www.voanews.com/a/speeding-west-ukraine-hospital-train-ferries-patients-to-safety/6523658.html).

Nevertheless, all signs point to Ukraine holding the medical advantage in this war. Medicine is of course not enough. The Finns likewise held the medical advantage over the Soviet Union in the 1939 Winter War. Finland used insulated medical aid stations, evacuated casualties by

sled, and had generally better medical staffing and facilities. Although the war ultimately ended with a Soviet victory, medicine was

nonetheless a force multiplier for the Finns, who had a much smaller population and were able to compromise the Soviet victory instead of being overrun. In a war where numbers matter, the side that has better medicine holds a distinct advantage.